Heart failure supported by veno-arterial extracorporeal membrane oxygenation (ECMO): a systematic review of pre-clinical models

Heinsar, Silver; Rozencwajg, Sacha; Suen, Jacky; Bassi, Gianluigi Li; Malfertheiner, Maximilian; Vercaemst, Leen; Broman, Lars Mikael; Schmidt, Matthieu; Combes, Alain; Rätsep, Indrek; Fraser, John F.; Millar, Jonathan E.

doi:10.1186/s40635-020-00303-5

Intensive Care Medicine Experimental

Table 2 Criteria used to define cardiogenic shock adapted to animal practice

From: Heart failure supported by veno-arterial extracorporeal membrane oxygenation (ECMO): a systematic review of pre-clinical models

	Clinical criteria			Hemodynamic criteria		Cardiogenic shock adequately defined?	Cardiogenic shock achieved?
	Arterial hypotension^a	Pulmonary congestion^b	End-organ hypoperfusion^c	Low cardiac output^d	Elevated filling pressure^e	Cardiogenic shock adequately defined?	Cardiogenic shock achieved?
Dogs
Sakamoto et al.	−	−	−	−	LAP > 10 mmHg	No	N/A
Kawashima et al.	−	−	−	−	−	No	N/A
Yu et al.	No predefined criteria					No	N/A
Ox
Segesser et al.	“pressure drop”	−	−	−	−	No	N/A
Pigs
Møller-Helgestad et al.	−	−	SvO₂ ≤ 35%	+	−	Yes	Yes
Ostadal et al.	−	−	−	+	−	Yes	Yes
Simonsen et al.	−	−	−	+	−	Yes	Yes
Janak et al.	+	−	−	+	−	Yes	No
Vanhuyse et al.	+	−	+	+	−	Yes	Yes
Esposito et al.	No predefined criteria					No	N/A
Hala et al.	Cardiogenic shock not studied					N/A
Itoh et al.	No predefined criteria					No	N/A
Ostadal et al.	+	−	+	−	−	Yes	Yes
Brehm et al.	+	−	−	−	+	Yes	No
Kajimoto et al.	No predefined criteria					No	N/A
Zhu et al.	+	−	−	−	−	Yes	No
Bartoli et al.	−	−	Reduction of SvO2 by 10%	+	Elevation of LAP ≥ 5 mmHg	Yes	Yes
Sheep
Sauren et al.	−	−	−	−	−	No	N/A
Naito et al.	MAP reduction > 20 mmHg	−	−	+	LAP increase > 10 mmHg	Yes	Yes

Data were divided into clinical and hemodynamic variables with “+” indicating the criterion was met and “−” indicating the criterion was not met. When a criterion was correctly defined but met a different threshold, we considered the criterion to be met and wrote the precise threshold used in the study. We considered that a study had defined cardiogenic shock adequately if (i) it was consistent with the guidelines in force at the time of the experiment; (ii) it used a combination of two criteria present in any guidelines including at least one clinical criterion; or (iii) it used one criterion in the context of acute heart failure induction. We considered that a study had achieved cardiogenic shock if those criteria were met during the experiment. Otherwise, it was considered as “acute heart failure without cardiogenic shock”.
LAP left atrial pressure; MAP mean arterial pressure; SvO2 venous saturation of oxygen
^aSystolic blood pressure < 90 mmHg or inotrope, mean arterial pressure (MAP) < 65 mmHg, or > 20% drop in MAP. Based on criteria from SHOCK and IABP-SHOCK II Trial and NICE Clinical Guidelines
^bCriteria from IABP-SHOCK II trial
^cAltered mental status, cold/clammy skin and extremities, urine output < 0.5 mL/kg/h, pH < 7.35, elevated serum creatinine, lactate > 2.0 mmol/L. SvO₂ threshold based on criteria from SHOCK and IABP-SHOCK II Trial, NICE, and ESC Clinical Guidelines
^dCardiac index (CI) ≤ 2.2 L/min/m² or cardiac output (CO) < 3.5 L/min or > 20% drop in CO. Based on criteria from SHOCK and IABP-SHOCK II Trials and ESC Clinical Guidelines
^ePulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg or increased left atrial pressure (LAP). Based on criteria from SHOCK Trial and ESC Clinical Guidelines

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